New instrumental set for the assessment of the hand functionality

Arthrodesis Versus Arthroplasty in Thumb Carpometacarpal Osteoarthritis: Impact on Maximal Voluntary Force, Endurance, and Accuracy of Pinch

PURPOSE

To investigate differences in pinch strength recovery among patients with first carpometacarpal joint osteoarthritis treated with either arthrodesis or suspension arthroplasty.

METHODS

Thirty-seven subjects who underwent arthrodesis or suspension arthroplasty for carpometacarpal osteoarthritis were included. Force exerted during maximal voluntary contraction (MVC) in a pinch task was measured. Maximal voluntary contraction was recorded using a haptic device equipped with a load cell from which an analog signal was acquired and digitized for visual feedback. Dynamic force was assessed by a task consisting of 10 repetitions, with a target of 70% of MVC. Endurance was assessed by the length of sustained pinch task at 30% of MVC. Task performance was quantified by mean distance and offset error from the target force as error indices, and standard deviation of force was used as index of force steadiness.

RESULTS

The arthrodesis group obtained considerably higher MVC values than the arthroplasty group. No notable differences were found for pinch endurance. The standard deviation for dynamic force was lower for arthroplasty, indicating greater force steadiness.

CONCLUSIONS

Arthrodesis is associated with greater pinch strength. Arthroplasty is associated with better pinch precision.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Health technology assessment of a homecare device for telemonitoring and telerehabilitation for patients after hand transplantation

Hand rehabilitation requires continuous and frequent monitoring of the functionality in order to assess therapy and/or refine it. In order to contain costs for the rehabilitation program, a telehomecare rehabilitation system is suitable. The purpose of this paper was to describe the setup and configuration of a homecare device for telemonitoring/telerehabilitation of patients who underwent hand transplant. The telehomecare device allows the assessment of dynamics and kinematics of hand function by integrating dedicated software in two components. The first was a commercial glove, the HumanGlove by Humanware (Pisa, Italy). The second was a set of instruments for the measurement of digit force using an Instrumented Keyboard and an Instrumented Mouse-Like device. The software integrating the devices is composed of two modular components. The first is to drive the devices; the second is for the data-analysis and display. The methodology was validated at the Istituto Superiore di Sanit (the Italian National Institute of Health) in the framework of an Italian National Project, funded by the Ministry of Health.

Validation of a tele-home-care for hand-telerehabilitation

The hand rehabilitation process needs a continuous and frequent monitoring of the patient's functionality in order to test the delivered therapy and/or adapt it to the patient's progress. In order to contain costs for the rehabilitation program, a tele-homecare rehabilitation system is suitable. We have proposed a tele-home-care allowing the assessment of the hand fingers' dynamics and kinematics by integrating with a dedicated software two particular devices: the first was a commercial glove, the HumanGlove by Humanware (Pisa, Italy) and the second was a set of instruments for the measurement of the hand fingers' force comprehending an Instrumented Keyboard (IK) and an Instrumented Mouse-Like (IML) device. The platform has been successfully tested at Istituto Superiore di Sanità (ISS).

Experimental protocol for the kinematic analysis of the hand: definition and repeatability

A quantitative and objective method based on the optoelectronic kinematic analysis of hand segments and on the calculation of global and partial parameters, which provide measures of the degree of long finger and thumb extension is proposed for the evaluation of the hand's voluntary range of motion and maximal opening of the fingers and thumb. To test the precision and repeatability of the method, the protocol was applied on 14 healthy subjects (28 hands). The proposed parameters are repeatable and show a precision between 5.5 degrees and 10.4 degrees (mean value: 7.3 degrees), comparable to values obtained with other methods. Advantages of the present approach include simultaneous analysis of all fingers, absence of cumbersome connecting cables and no need for individually customized devices. The method, also applied to the paretic hands of two hemiplegic stroke patients before and after electrical stimulation of the wrist and finger extensor muscles, has shown encouraging results for its clinical feasibility and utility in addition to functional tests.